Medicaid Terminology

Aler Stallings

Medicaid lingo can be confusing. Below are some of the more common Medicaid terms.

Asset

Vehicles, real property, business interests, and financial assets like stocks, bonds, bank accounts, retirement accounts, annuity contracts, life insurance policies, and any other property that can be converted into cash to pay for care. Medicaid has strict asset restrictions that must be met to qualify for eligibility. An individual or a community spouse will only be allowed to keep a limited amount of assets in their own name.

Authorized Representative

The person (18+) designated by the applicant, in writing, to be his/her representative in the Medicaid application process. If the representative has legal guardianship or power of attorney, proof must be presented at the interview

Community Spouse

A married individual that does not need Medicaid assistance.

Estate Recovery

After the death of the Medicaid recipient, the State Attorney General’s Office attempts to recover funds for any medical payments that have been paid by Medicaid.

Improper Transfer

A transfer of assets in order to qualify for Medicaid. Improper transfers can include unreimbursed transfers or transfers made below fair market value. Medicaid requires documentation from the applicant for the past five years to identify any improper transfers.

Income

Includes cash and other items of value that are available and attributable to the Medicaid applicant. Income includes both earned and unearned income and even items such as food and shelter. Common income sources are Social Security, pension income, and a VA benefit.

Institutionalized Spouse

The individual that needs long-term care assistance.

Level of Care

Determines the medical necessity of nursing home care. Medicaid cannot authorize payment to the nursing facility without the assessment. The level of care is valid for up to 30 days before admission.

Minimum Monthly Maintenance Needs Allowance (“MMMNA”)

If the community spouse’s income does not meet the minimum standard, a community spouse may receive additional income from the institutionalized spouse in order to have minimum income to maintain the household.

Patient Liability

The amount of the Medicaid applicant’s monthly income that must be contributed to the cost of their care.

Qualified Income Trust (“QIT”)

When income exceeds the amount required for Medicaid eligibility, a QIT is needed. The income above the special income limit is placed in the QIT and used for permitted expenses. A QIT must have a Medicaid payback provision and is sometimes referred to as a “Miller Trust”.

Resource Assessment

An accounting of the resources of both the institutionalized spouse and the community spouse to determine the couple’s total resources that exist(ed) at the beginning of the first continuous period (30 days or more) of institutionalization including hospital stays.

Snapshot Date

The first day of a period of 30 continuous days in either a long-term care facility or a hospital or a combination of both. The snapshot date determines the resources that a married couple can keep during the Medicaid process.

Spousal Resource Standard

The maximum amount of a couple’s resources allowed for use by the community spouse. The standard is revised on January 1st every year. Current standards can be obtained by calling The Department of Senior and Adult Services Medicaid Benefits Division.

Waiver Program

Provides alternatives to nursing home long term care. Allows participants to have more control of their lives and remain active in their community.